HomeMy WebLinkAboutZ-29577FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 29577
THIS CERTIFIES that the building
DWELLING
Date: 07/16/03
Location of Property 13905 MAIN RD MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 140 Block 0003 Lot 029
Subdivision
Filed Map No. Lot No.
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z- 29577 dated JULY 16, 2003
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH ACCESSORY THREE CAR GARAGE
The certificate is issued to SOPHIE JEROME
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL
NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
(OWNER)
N/A
N/A
N/A
hor' ed Signature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 13905 MAIN RD MATTITUCK
SUBDIVISION: NAP NO.: IAT (S)
NAME OF OWNER (S): SOPHIE JEROME
OCCUPANCY: SINGLE FAMILY DWELLING SOPHIE JEROME
ADMITTED BY: THEODORE SWANSON ACCOMPANIED BY: SAME
KEY AVAILABLE: BUFF. CO. TAY MAP NO.: 140.-3-29
SOURCE OF REQUEST: CHARLES E. RAFFEE, ATTY 7/8/03 DATE: 07/16/03
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 2.0 # EXITS: 3
FOUNDATION: CEMENT BLOCK CELLAR: FULL CRAWL SPACE:
TOTAL ROOMS: 1ST FLR.: 3 2ND FLR.: 3 3RD FLR.: 0
HATHROOM(S): 2.0 TOILET ROOM(S): 0.0 UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE: COVERED RAISED PATIO
BREEZEWAY: FIREPLACE: ONE GARAGE:
DOMESTIC HOTWATER: YES TYPE HEATER: OFF BOILER AIRCONDITIONING-
TYPE BRAT: OIL WARM AIR: HOTWATER: XX
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF COMET.: 3 CAR WOOD FRAME STORAGE, TYPE CONST.:
SWIMMING POOL: GUEST, TYPE CONST.:
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
INSPECTED BY:- DATE ON INSPECTION: 07/15/03
GARY IS TIME START: 10:20 AM END: 10:45 AM
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT, JILL _ $ 2003
TOWN HALL
765-1802 {
APPLICATION FOR CERTIFICATE OF O`n
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage -disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non -conforming uses, or buildings and "pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00.
,2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. July 7, 2003
New Construction: Old or Pre-existing Building: X (check one)
Location of Property: 13095 Plain Road 11attituck
House No. Street Hamlet
Owner or Owners of Property: Sophie Jerome
Suffolk County Tax Map No 1000, Section 140.00 Block 03.00 Lot 029.000
Subdivision N/A Filed Map. N/A Lot: N/A
Permit No. N/A Date ofPerrnit. N/A Applicant: N/A
Health Dept. Approval: N/A Underwriters Approval: N/A
Planning Board Approval: N/A
Request for:
Temporary Certificate N/A
Fee Submitted: $ 100.00
Q.ec, b y 3 //
6V rd -f_ aqs ,7 7
Final Certificate: N/A (check one)
'�yQ lz J
Applicant ig ature
SOPHIE JERO?4E BY ANNE J. SWANSON,
ATTORNEY—IN—FACT
CONSENT TO INSPECTION
SOPHIE JEROME the undersigned, do(es) hereby state:
Owner(s) Name(s)
That the undersigned (is) (are) the owner(s) of the premises in the Town of
Southold, located at 13095 Main Road, Mattituck
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section Block Lot
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following: to obtainh a
Certificate of Occupancy on Pre -Existing Building
That the undersigned do(es) hereby give consent to the Building Inspectors of the
Town of Southold to enter upon the above described property, including any and all
buildings located thereon, to conduct such inspections as they may deem necessary with
respect to the aforesaid application, including inspections to determine that said premises
comply with all of the laws, ordinances, rules and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so with the knowledge
and understanding that any information obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laws, ordinances, rules or
regulations of the Town of Southold.
A=
Dated: July 7, 2003
SOPHIE J&1e �ffe)MM J. S;WSON,
ATTORNEY-IN-FACT
(Print Name)
(Signature)
(Print Name)
CHARLES E. RAFFE
ATTORNEY AND COUNSELLOR AT LAW
,a7 EAST SLAIN STREET
F. O. RON 29n
RIA'ERHEAD, NENYORK 10101
631-727-3662-3
TELECOF ER NO: 631-727-2761
ESSERS, HEFTER & .AN(iM, SOLOMON RAFFE
OF cooNSEL July 7 2003 111011-19M1
Town of Southold
Building Department
Southold Town Hall
Main Road
Southold, New York 11971
Re: Sophie Jerome to Joseph S. Grattan and Tracey Grattan
Premises: 13905 Main Road, Mattituck, New York
Dear Sir or Madam:
I represent Sophie Jerome who is in the process of
selling her home located at 13905 Main Road, Mattituck, new
York. In connection therewith, please find enclosed
herewith the following:
1. Mrs. Jerome's Application for a Certificate of
Occupancy for Pre -Existing Building executed by her
daughter, Anne J. Swanson, her Attorney -in -Fact.
2. A copy of the Power of Attorney of Mrs. Jerome
appointing Mrs. Swanson her Attorney -in -Fact.
3. The executed Consent to Inspection Form.
4. An original current -dated survey print of the
subject premises.
5. My Office Check for $100.00 to the Town of Southold
for the Application Fee.
Please be advised that you should call Anne J. Swanson
or her husband, Theodore Swanson at 765-5735 to arrange for
access to the subject premises.
1
Trusting your find these enclosures satisfactory,
please process my client's Application at this time.
Ver
y
trruuly yours,
r
CHARLE RAFFE
CER/mg
Enclosures
CC: Anne J. Swanson and Theodore Swanson
2
FORM M133-DMAIS 97
Power of Avonmy. Smmmry Sion Farm, Revicd 1/1/1997 - (with ARitlovii of E@cdvenss a 199) FNeliiy Nafiowl Title Imurercc Company of New York)
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT -THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
DURABLE GENERAL POWER OF ATTORNEY
NEW YORK STATUTORY SHORT FORM
THE POWERS YOU GRANT BELOW CONTINUE TO BE EFFECTIVE
SHOULD YOU BECOME DISABLED OR INCOMPETENT
(CAUTION: THIS IS AN IMPORTANT DOCUMENT. IT GIVES THE PERSON WHOM YOU DESIGNATE
(YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY DURING YOUR LIFETIME, WHICH
MAY INCLUDE POWERS TO MORTGAGE, SELL, OR OTHERWISE DISPOSE OF ANY REAL OR
PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THESE
POWERS WILL CONTINUE TO EXIST EVEN AFTER YOU BECOME DISABLED OR INCOMPETENT.
THESE POWERS ARE EXPLAINED MORE FULLY IN NEW YORK GENERAL OBLIGATIONS LAW,
ARTICLE 5, TITLE 15, SECTION 5-1502A THROUGH 5-1503 WHICH EXPRESSLY PERMIT THE USE OF
ANY OTHER OR DIFFERENT FORM OF POWER OF ATTORNEY.
THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL OR OTHER IiEALTH CARE
DECISIONS. YOU MAY EXECUTE A HEALTH CARE PROXY TO DO THIS.
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK
A LAWYER TO EXPLAIN IT TO YOU.)
THIS is intended to constitute a DURABLE GENERAL POWER OF ATTORNEY pursuant to Article 5, Title 15 of
the New York General ObliKations Law:
SOPH IJEROME
.. ....... .. residing at.(No.#) Main Road, Mattituck, NY 11952
I . ..........
(insert your name and address)
do hereby appoint:........ .............. . residing at .......................................... .
...
(If 1 person is to be appointed agent, insert the name and address of your agent above)
ANNE J. SWANSON .... residing at 1345 ShiPS Drive, Southold,_NY 11971
W. THEODORE SWANSON .,, residing at 1345.Ships.Drive,, SouthPid,.NY..11971.......
... HE'61*RE S . ...
.. residing at ... ................. .......... .
(If 2 or more persons are to be appointed agents by you insert their names and addresses above)
my attomey(s)-in-fact TO ACT (If more than one agent is designated, CHOOSE ONE of the following two choices by
putting your Initials in ONE of the,blank spaces to the left of your choice:)
Each agent may SEPARATELY act.
( ) All agents must act TOGETHER.
(If neither blank space is initialed, the agents will be required to act TOGETHER)
IN MY NAME, PLACE AND STEAD in any way which I myself could do, if 1 were personally present, with respect to
the following matters as each of them is defined in Title 15 of Article 5 of the New York General Obligations Law to the
extent that I am permitted by law to act through an agent
(DIRECTIONS: Initial in the blank space to the left of your choice any one or more of the following lettered
subdivisions as to which you WANT to give your agent authority. If the blank space to the left of any particular
lettered subdivision is NOT initialed, NO AUTHORITY WILL BE GRANTED for matters that are included in that
subdivision. Alternatively the letter corresponding to each power you wish to grant may be written or typed on the
blank line in subdivision (Q)", and you may then put your initials in the blank space to the left of subdivision "(Q)"
in order to grant each of the powers so indicated)
( ) (A) real estate transactions; ( ) (M) making gifts to my spouse, children and more
( ) (B) chattel and goods transactions; remote descendants, and parents, not to exceed in
( ) (C) bond, share and commodity transactions; the aggregate $10,000 to each of such persons in
( ) (D) banking transactions; any year;
( ) (E) business operating transactions; ( ) (N) tax matters;
( ) (F) insurance transactions; ( ) (0) all other matters;
( ) (G) estate transactions, ( ) (P) full and unqualified authority to my
( ) (H) claims and litigation; attorney(s)-in-fact to delegate any or all of the
( ) (1) personal relationships and affairs; foregoing powers to any person or persons whom
( ) (J) benefits from military service; my attorney(s)-in-fact shall select;
( ) (K) records, reports and statements; ( 19 (Q) each of the above matters identified by the
( ) (L) retirement benefit transactions, following letters: A,. 13, . C, .1). .8,. F,.G,. H,. .
I, J, K, L, M, N, O and P
(Special provisions and limitations may be included in the statutory short form durable power of attorney only if they
conform to the requirements of section 5-1503 of the New York General Obligations Law)
............................................................................. I...............
................................................................................ I .... .......
............................................................................................
Special Additional Provision: The powers granted under (A) through (C) above shall include the sale of a cooperative
housing unit and are enlarged so that all fixtures and articles of personal property which at the time of such Iransactlon are
or which may thereafter be attached to or used in connection with the real or personal property may be included in the
agreements or other instruments to be executed and delivered in connection with any transactions and which maybe
described in said instruments with more particularity. This Power of Attorney is not subject to question because an
instmmen[ executed hereunder fails to recite or recites only nominal consideration paid therefore and any person dealing with
the subject matter of such instrument may do so as if full consideration had been expressed therein.
This durable power of attorney shall not be affected by my subsequent disability or incompetence.
If every agent named above is unable or unwilling to serve, I appoint ...................................... .
.. residing at ..... ................... .
(insert name and address of successor)
to be my agent for all purposes hereunder.
TO INDUCE ANY THIRD PARTY TO ACT HEREUNDER, I HEREBY AGREE THAT ANY THIRD PARTY
RECEIVING A DULY EXECUTED COPY OR FACSIMILE OF THIS INSTRUMENT MAY ACT HEREUNDER,
AND THAT REVOCATION OR TERMINATION HEREOF SHALL BE INEFFECTIVE AS TO SUCH THIRD
PARTY UNLESS AND UNTIL ACTUAL NOTICE OR KNOWLEDGE OF SUCH REVOCATION OR
TERMINATION SHALL HAVE BEEN RECEIVED BY SUCH THIRD PARTY, AND I FOR MYSELF AND FOR
MY HEIRS, EXECUTORS, LEGAL REPRESENTATIVES AND ASSIGNS, HEREBY AGREE TO INDEMNIFY
AND HOLD HARMLESS ANY SUCH TSD PARTY FROM AND AGAINST ANY AND ALL CLAIMS THAT
MAY ARISE AGAINST SUCH THIRD PARTY BY REASON OF SUCH THIRD PARTY HAVING RELIED ON
THE PROVISIONS OF THIS INSTRUMENT.
THIS DURABLE GENERAL POWER OF ATTORNEY MAY BE REVOKED BY ME AT ANY TIME.
IN WITNESS WHEREOF I have hereunto signed my name this IGj... day of ......May......... , 19. 9.7
(YOU SIGN HERE:) r f% d'' f'- L c Y. " "c ..... .
SOpHIE t$t Imre ofPrinmppal) J�E'ROME�
The xwwte regairenhut this invrvmem be acknowledged brthepnncipal No uprexe prwmonumadejo. pr J6y subs bing wnnesx.
STATE OF
FFj NEW YORK, COUNTY OF SUFFOLK )SS.:
On We /-/ day of May . 19 97. before me
personally cane SOPHIE JEROME
to me known to be the individual described in and who executed the
foregoing instrument and acknowledged that she executed the same.
STATE OF NEN' YORK, COUNTY OF ISS:
On the day of , 19 , before me
personally cane
to me known to be the individual described in and who executed the
foregoing instrument and acknowledged that he executed the sonc.
ntt t ��LuF�iJ
No ry Public
�bk�l'P1d400
Ah -14V
AFF/DAITear EFF£CIIV£N£SS e
STATEOFNew YORK.COUNTVOF Isx:
................................................... I ........................ ......... ... . residing at
................................................................................. being duly sworn does depose and
say that I ant the Attorney-ln-Pact under the above Power ofAlowney. That said Power of Attorney is a valid and subsisting Power which has
not been revoked by the death of the principalis) or otherwise; that I have no actual knowledge of a revocation of the foregoing Power; and, I
warrant and represent that I have full and unqualified authority to execute the ............................. /Deed, Mortgage, etc.]
knowing that.................................................................................... will rely upon
n
the representations made herein as inducement to accept such histrmnent(s) and this Power of.4ttorney as evidence army authority to act.
WORNAND SUBSCRIBED TO BEFORE Are THIS DAl'OF ,/9 Attorney %n FRa
..................................................
(Notary Afl Smmp in Right)
�arahlr $rarral Taber of Attoruq
REVISED SFAMORY SHORT FORM
TITLE No.
SOPHIE JEROME
To
ANNE J. SWANSON or
anavty
FIDELITY NATIONAL TITLE
INSURANCE COMPANY OF NY
'C xse ria Fidelity
Member New York State Land Title Association
DISTRICT
SECTION
BLOCK
LOT
COUNTY OR TOWN
RECORDED AT TI/E REQUEST OF
Fidelity National Title Insurance Company of New York
RervwverMAU To:
00W or N
G \-OrfCtne N
N
M N\N RU N�
0 - NONUMENT SET 0 - MONUMENT FOUND A - STAN[ SET ♦ = STAKE vourvo 0 - DRILL HOLE 4T
E
Young & Young
400 Ostrander Avenue, Riverhead, New York 11901
631-727-2303
Howard W Young, Land Suroeyor
Thomas C. Wolpert, Professional Engineer
Robert C. Tact, Architect
Ronald E Pfuhl, Landscape Architect
NOTE
AREA = 26,652 SQ. FT.
SURVEYOR'S CERTIFICATION
• WE HEREBY CERTIFY TO JOSEPH S. GRATTAN,
TRACEY A. GRATTAN, SUFFOLK COUNTY
NATIONAL BANK & FIDELITY NATIONAL TITLE
INSURANCE COMPANY OF NEW YORK THAT THIS
SURVEY WAS PREPARED IN ACCORDANCE WITH TH_ `A
PRACTICE FOR LAND SURVEYS ADOPTED BY W
ASSOCIATION, OF PROFESSIONAL LAND SURV I, C
HOWARD W. YOUNG, N.YS LS. NO 45893
SURVEY FOR
JOSEPH S. GRATTAN
& TRACEY A. GRATTAN
At Mattituck, Town of Southold
Suffolk County, New York
County Tax MOP o,sEict 1000 s -i- 140 e., 03 sol 29
TITLE �IJFR�/E�
MAP PREPARED JUNE 26, 2003
SCALE 1" = 30' TCS
JOB NO. 2003-0231 I J
DWG 2003_0231 _ts
LOCATION:
(number & street)
SUBDIVISION:
NAME OF OWNER(S):
OCCUPANCY:
MAP NO.:
(municipality)
LOT(S):
(type) (owner -tenant)
ADMITTED BY: ACCOMPANIED BY: �Z' �
KEY AVAILABLE: SUFF. CO. TAX MAP NO. 1000 -
SOURCE OF REQUEST:
DATE:
DWELLING: , Q
TYPE OF CONSTRU TION: �`�
�# STORIES: # EXITS:
FOUNDATION: T CELLAR: CRAWL SPACE:
TOTAL ROOMS: 1ST FLR: 33 2ND FLR: 3RD FLR:
BATHROOM(S): TOILET ROOM(S): UTILITY ROOM:
PORCH TYPE: DECK, TYPE: PATIO, TYPE:
BREEZEWAY: FIREPLACE: ARAGE:
DOMESTIC HOTWAr + R:$ TYPE HEATER: _ CONDITIONING: _-------
TYPE HEAT: WARM AIR: HOTWATER:
OTHER:
3
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.:
SWIMMING POOL: GUEST, TYPE CONST:
OTHER:
VIOLATIONS: CHAPTER 45 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION I DESCRIPTION I ART. I SEC.
REMARKS:
INSPECTED BY: DATE ON INSPECTION: %
ll&
TIME START: 0 = a0 END:
TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER
STREET;
VILLAGE
DIST.
SUB. LOT�211,,,
vQ �a ro6ILL
to �'��tva;
pis
FO ER OWNER
N
E'
ACR.
.... ....... .
S
W
TYPE OF BUILDING
SEAS.
VL.
FARM
COMM. CB. MICS. Mkt.. Value
LAND
IMP.
TOTAL
DATE
REMARKS --
&
;.. ..
`
AGE
BUILDING CONDITION
NEW
NORMAL
BELOW ABOVE
FARM
Acre
Value Per
Acre
Value
Tillable
FRONTAGE ON WATER
Woodland
FRONTAGE ON ROADgo
Meadowland
DEPTH
House Plot
BULKHEAD
Total �./ �,
�. `�-�
DOCK